Patient's family in denial

[standardprecautions]

Not sure if this has been discussed before, but I am currently looking after an elderly patient who is medically deteriorating. Patient had been referred to palliative care team. However, the family seems to be in denial of the situation. Everytime they come and see the patient they will say that she is "improving" and they do not want palliation for her. Every time I come into the patient's room to do turning or other comfort measures, a family member would say "she looks much better today" or "she is really improving".

What would be an appropriate response to these statements? I cannot agree with them as patient is not improving at all, but I can't tell them that. Have any of you been in this situation and how did you talk to the family?

[offlabel]

Saying that someone is in denial implies that they are being irrational on some level and might be dismissive of their perception of the situation. Is it denial or have they never seen someone die before? When we live in our day to day bubble of life and death, we really run the risk of projecting our knowledge on to other people and raise our expectations to unreasonable levels.

Why not just say something like, "yes, she's having a better day today". Meet the family where they are with condition neutral statements. Be very open and frank with what her needs are and will be in the near future.

[blondy2061h, MSN, RN]

Ask them what they see that looks better. You can gently say things like "Yes, it's encouraging that she is tolerating her tube feedings better today, but she's still not having much urine output, which means her kidneys aren't working well. Her blood pressure is at a good place right now, but we're using a lot of medications to keep it there, which means she's very critically ill. Can I answer any questions for you?"

[LovingLife123]

This is a common occurrence. To us, it's obvious and they are our patient, but this is their loved one, their life.

What I will often say is yes, they have had some improvements today and here is where they are with the rest. I hate dashing anybody's hope because sometimes that is all they have.

And I will tell you, there have been many times I have been like this person is never making it, and they end up with a full recovery!!! Even in the elderly.

[Jules A, MSN]

Make sure the attending knows because they should be educating the family on a realistic prognosis.

[oceanblue52]

Often times too people do not really "get" what palliative care is; they think that once a loved one gets referred that it is a death sentence and that all treatments will be stopped. Might be worthwhile for someone on the palliative care team to meet with the family and explain the difference between their services and hospice. Have found in my clinicals that people are more open to palliative care if it is framed as a quality of life intervention.

[heron, ASN, RN]

Remember: denial is a normal part of the grieving process. It serves a purpose by blunting the emotional impact of an impending loss until the family is ready to accept it. The gentle, respectful approach of continuously presenting the facts without trying to force them to acknowledge the patient's impending death, as suggested by PP, is probably the most effective one.

It takes the time that it takes.

[Palliative Care, DNP]

Just a typical day for me. I hear this multiple times a day. It doesn't necessarily mean the family is in denial. It does mean they aren't ready for the discussion. Forcing the discussion only makes them stop listening. Meet them where they are. Listen. Be empathetic. Families will start asking questions when there is a change or when they are ready. As mentioned above, most folks think we are the Reaper. Palliative does not mean no Care nor Hospice. We also manage chronic illnesses such as MS, ALS, & Sickle Cell etc.